P3435 - Temporal Trends in Clostridioides difficile-Associated Mortality in the United States: A 25-Year Retrospective Analysis (1999-2023)

Furqan Hassan, MBBS¹, Muhammad Tayyab Ijaz, MBBS², Samiksha Jain, MBBS³, Amyla Amjad, MBBS⁴, Uswa Hasana, MBBS⁵, Ammara Khalid, MD⁶, Rafia Irfan Waheed, MD⁷, Daniyal Warraich, MBBS⁸
1Nishtar Medical University, Multan, Punjab, Pakistan; 2CMH Lahore Medical College, Lahore, Punjab, Pakistan; 3Guntur Medical College, India, Guntur, Andhra Pradesh, India; 4University of North Dakota, School of Medicine and Health Sciences, Fargo, ND; 5Fatima Jinnah Medical University, Lahore, Punjab, Pakistan; 6Atlanta Gastroenterology Associates, Griffin, GA; 7University of South Dakota Sanford School of Medicine, Sioux Falls, SD; 8Bronx Care, Bronx, NY

Introduction: Clostridium difficile enterocolitis (CDE) is a significant cause of morbidity and mortality, especially in older adults who are at high risk for this infection. However, data allowing insight into its mortality trends is unexplored. Our study looks over the past 25 years (1999-2023) to uncover trends and disparities in CDE mortality.

Methods: Mortality data was obtained from CDC WONDER for individuals aged ≥ 55 years using ICD-10 code (A04.7). Age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Joinpoint regression analysis was used to estimate annual and average annual percentage change (APC & AAPC), with statistical significance defined as 95% CI excluding zero (p < 0.05).

Results: A total of 206,615 deaths occurred from CDE. AAMR started from 2.57, abruptly rose till 2005 (12.91) [APC: 34.2 (95% CI, 25.8 to 38.6)], with a much slower rise occurring till 2011 (16.91), followed by a decline till 2023 (7.38) [AAPC: 5.13 (95% CI, 2.83 – 7.48)]. Females had most deaths (58.6%), but males (11.41) had slightly higher AAMR average than females (10.84). Females AAMR rose sharply from 1999 (2.37) till 2005 (12.46) [APC: 34.59], with a much slower rise till 2011 (16.76) and a subsequent decline till 2023 (7.31). Males AAMR rose sharply from 1999 (2.91) till 2005 (13.7) [APC: 32.00], followed by a slow rise till 2008 (17.15) and a subsequent fall till 2023 (7.45). NH Whites had the greatest deaths (84.98%) and AAMR average (11.72), followed by NH Blacks (7.54%) (9.36) and Hispanics (5.17%) (7.86). Individuals aged 75 and over had most deaths (72.59%) and a consistently higher AAMR trend, starting from 7.01 and rising till 2008 (47.00), before declining till 2023 (17.65). AAMR of individuals between 55-74 years, started from 0.82 and went up to 5.23 in 2016, before declining to 3.34 in 2023. Northeast had the highest average AAMR (12.59) and 22.45% deaths, followed by Midwest (12.04) (24.49%), West (10.25) (19.21%) and South (9.99) (32.93%). Urbanization data, limited to 2020, revealed higher deaths (74.78%) and AAMR in metropolitan areas (11.93) vs nonmetropolitan (10.61). From 1999-2020 Rhode Island (25.42) had the highest AAMR, while from 2021 till 2023 Kentucky did (14.5).

Discussion: Despite an initial rise in mortality, a significant downward trend has been seen in the past decade. However, it is not uniformly benefiting all populations, with Hispanics and those aged between 55-74 being less benefited. Males, NH Whites and those aged 75+ remain at an overall increased risk.


Figure: Tables of APC/AAPC Mortality Trends from 1999-2023 according to (a) Overall Population; (b) Age Groups; (c) Race/Ethnicities.


Figure: Mortality Trends and Table of APC/AAPC according to Census Regions from 1999-2023, alongwith Mortality Trends according to Urbanization status and States from 1999-2020.

Disclosures:
Furqan Hassan indicated no relevant financial relationships.
Muhammad Tayyab Ijaz indicated no relevant financial relationships.
Samiksha Jain indicated no relevant financial relationships.
Amyla Amjad indicated no relevant financial relationships.
Uswa Hasana indicated no relevant financial relationships.
Ammara Khalid indicated no relevant financial relationships.
Rafia Irfan Waheed indicated no relevant financial relationships.
Daniyal Warraich indicated no relevant financial relationships.

Furqan Hassan, MBBS¹, Muhammad Tayyab Ijaz, MBBS², Samiksha Jain, MBBS³, Amyla Amjad, MBBS⁴, Uswa Hasana, MBBS⁵, Ammara Khalid, MD⁶, Rafia Irfan Waheed, MD⁷, Daniyal Warraich, MBBS⁸. P3435 - Temporal Trends in <i>Clostridioides difficile</i>-Associated Mortality in the United States: A 25-Year Retrospective Analysis (1999-2023), ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.